Objective: Cesarean Section (CS) is a commonly performed procedure for women, with almost a third of women in many developed countries experiencing when they give birth. CS is still being perceived as an abnormal means of delivery by many antenatal women in remote areas of Pakistan. Aim of the study is to determine the perceptions of antenatal clients in the North West of Pakistan on CS. Materials and methods: A self-administered questionnaire based survey was designed. Subjects were enrolled from September 2009 to December 2009 in Women and Children Teaching Hospital Bannu, Pakistan. Pre-validated, self-developed questionnaire was used for study data. The data was fed to Statistical Package for Social Sciences (SPSS 16 ®) to analyze and presented in a simple frequency table. Results: Of 450 pregnant patients, 402 responded the questionnaire. Age of the respondents ranged between 16 and 44 (27.21 ± 4.04) years. Only 7 (1.7%) viewed CS as feasible and elected to undergo CS. Seventy one (17.6%) considered CS good in case of threat to their lives, whereas 195 (48.6%) didn't accept CS in any circumstances. Only 35 (8.7%) women viewed CS uncomfortable in context of cultural barrier and a curse for women. Conclusion: Present study affirms previous suspicion that a significant proportion of antenatal clients are averse to CS and the negative cultural perception of the people to CS reinforced present aversion.

Objectives: To determine relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome Methods: This descriptive cross-sectional study was conducted in the department of Gynaecology, Lady Reading Hospital Peshawar, Pakistan, from January 2019 to July 2019. This study included 27 full-term pregnant women who had abnormal CTG during the active or latent phase of labour. Data were analyzed by IBM SPSS Statistics for Windows, Version 23.0. Results: Out of 27, most patients 13 (48.14%) were in the age group 20-25 years,11 (40.74%) to 26-30 years and 3 (11.11%) belonged to 31-35 years of age group. CTG abnormalities were severe bradycardia, late deccelerations and persistent variable deccelerations with loss of baseline variability. Of all delivered babies, 21 (77%) babies had birth weight<3.5 kg and 6 (22%) had >3.5 kg birth weight. 20 (74.07%) had acidosis (pH <7.2) at the time of birth, of which one had severe hypoxemia and acidosis with pH 6.85. APGAR score at 0 minutes showed a strong positive correlation (r=0.818, p= <0.001) with cord pH, while APGAR at five minutes was also strongly correlated (r= 773, p=<0.001). Of all babies 18(66.66%) with PH less than 7.2 were admitted in NICU while only 2 babies with PH more than 7.2 were admitted. (p value= 0.005). Conclusion: Low umbilical cord pH values of babies born by cesarean section (for fetal distress) are strongly correlated with low APGAR score at birth and higher rates of NICU admission. doi: https://doi.org/10.12669/pjms.36.7.2536 How to cite this:Syed W, Liaqat N, Qazi Q, Yasmeen S. Relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2536 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background and Objective: Obesity with its growing prevalence is a major public health problem influencing gestational age at delivery. Raised Body Mass Index (BMI) has been shown to be associated with significantly increased risk of prolonged pregnancy; which is an important contributor to perinatal morbidity and mortality. Obesity needs modified antenatal, intrapartum and postpartum care by obstetrician. Limited data is found regarding association of obesity with prolonged pregnancy and the same fact led us to search for this association. Methods: This cohort study was carried out in Gynecology and Obstetrics department, MTI Lady Reading Hospital Peshawar from March 2020 to April 2021. Patients were enrolled in third trimester at 37 weeks of gestation with primary exposures of interest being either self-reported pre-pregnancy weight or obtained from first trimester antenatal record. Patients were divided into two classes based on BMI i.e., one with BMI <25 and other with BMI ≥ 25. Patients in both classes were followed till their delivery to determine outcome of gestational age at delivery. Results: Statistically significant difference between the two groups was seen at lower age range of 18-21 years(p-0.04) and higher age range of 39-42 years (p-0.0001). Statistically significant association was found between high pre pregnancy BMI and postdates pregnancy (OR:4.93 ;95%CI:1.98-12.26, p-0.001). Association of induction of labor with high pre pregnancy BMI was not significant. (OR 0.56, 95%CI:0.21-1.48, P < 0.001). Higher rates of Instrumental deliveries(p-0.0005) and cesarean sections (p-0.0001) were seen in higher BMI group. Conclusion: Higher pre-pregnancy BMI is associated with increased risk of postdates pregnancy. doi: https://doi.org/10.12669/pjms.38.5.4815 How to cite this:Qazi Q, Liaqat N, Hussain SS, Syed W. Association of high Body Mass Index and postdates pregnancy. Pak J Med Sci. 2022;38(5):---------. doi: https://doi.org/10.12669/pjms.38.5.4815 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Primary postpartum haemorrhage (PPPH) is the leading cause of maternal morbidity and mortality in low resource countries like Pakistan. The objectives of this study were to determine the frequency, distribution by place of delivery and parity, causes, management options and outcome of PPPH in postpartum women of District Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Gynaecology & Obstetrics, Lady Reading Hospital, Peshawar, Pakistan from 1st January 2019 to 30th June 2019. Sample size of 4,034 was with 0.39342 % margin of error, 95% confidence level, prevalence of PPPH 2% and a population of 23,607 postpartum women. All postpartum women were eligible. Those with secondary PPH, surgical management for PPPH done at some other hospital, with known bleeding disorders and on anticoagulants were excluded. All these patients were managed according to standard protocols. Data was collected for following variables; presence of PPPH (yes/ no), place of delivery (in-hospital deliveries/ referred cases), parity (primipara/multipara/grandmultipara), causes of PPPH (uterus atony/retained placenta-RPOC/ruptured uterus/genital tract tears), management options of PPPH (conservative management/laparotomy with repair of ruptured uterus/laparotomy with uterine artery ligation and B-Lynch/repair of genital tract tears other than ruptured uterus/removal of retained placenta & RPOC/hysterectomy) and outcome of PPPH (uneventful recovery/maternal near miss/maternal mortality). Frequencies and percentages with confidence intervals were calculated for these variables. Results: Out of 4034 postpartum women, frequency of PPPH was 400 (9.92%). Out of 4034 women, distribution of 400 cases of PPPH by place of delivery was 222 (5.50%) in-hospital deliveries and 178 (4.42%) referred cases and by parity it was primipara 79 (1.96%), multipara 243 (6.03%) and grandmultipara 78 (1.93%) cases. Out of 400 cases of PPPH, frequency of uterine atony was 254 (63.50%) and conservative management 245 (61.25%). Out of 400 cases, frequency of uneventful recovery was 352 (88%), maternal near miss 40 (10%) and maternal mortality eight (2%) cases. Conclusion: Primary postpartum haemorrhage (PPPH) continues to be a common and serious complication of delivery with uterine atony being its most predominant cause.

Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified

Objective: To identify the frequency and type of cardiac diseases in pregnant women and their fetal and maternal outcome.

Purpose: To review the placenta weight birth weight ratio (PWBW ratio) and determine an association between PWBW ratio and gestational age in patients with placenta previa. Methodology: This descriptive cross sectional study took place in Gynae A unit, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan, from March 2018 to February 2020.Ethical approval from IRB (institutional review board) was taken before start of study. Patients with genital tract bleeding were admitted throughout patient department and Emergency with 28 weeks gestation and onwards. Diagnosis of placenta previa was confirmed and were included in study after taking consent. Results: Total of 173 patients with placenta previa were admitted in gynae A. Patients with major placenta previa were 151 (87.2%) while 22 (12.7%) patients had minor placenta previa. Birth weight placental weight ratio was calculated by measuring weight of placenta and baby after the delivery. Most of the patients, 92 (53.2%) had PWBW ratio less than 1:6 (relatively large placenta), patients with BWPW ratio of 1:6 (normal ratio) were 14 (8.1%) and 67 (38.7%) patients had PWBW ratio of 1:6 (relatively smaller placenta). Patients with placenta previa have relatively larger placenta (PWBW ratio less than 1:6) to compensate for lesser vasculature of lower uterine segment. Patients with larger placenta are prone to necrosis and abruption. Recommendation: igilant antenatal care and surveillance in these patients due to higher incidence of antepartum and postpartum hemorrhage, as well as invasive propensity of lager placenta.

Objective: To determine the fetal outcome of Caesarean Sections (CS) performed for abnormal Cardiotocography (CTG) Material and Methods: This retrospective data review was conducted in Gynaecology and Obstetrics unit B of Lady Reading Hospital Peshawar from June 2015 till June 2016 after approval from the hospital ethical committee, using a non-probability convenient sampling technique. The hospital record of 234 patients who had CS for fetal distress was reviewed. Patients with singleton and term gestation, who had CS for fetal distress diagnosed based on abnormal Cardiotocography were included in the study.  The fetal outcome was noted in terms of Apgar score at 5 minutes, admission to neonatal intensive care unit (NICU), and perinatal mortality. Fetal blood sampling (FBS) and postnatal analysis of fetal arterial blood gases and PH were not carried out in any patient because of non-availability. The results are expressed in frequencies and percentages, shown in tables and figures. Results: In one year, a total of 1255 C-sections were performed. Amongst these, 234 (18.64%) patients fulfilling inclusion criteria were enrolled. Babies delivered with 5 minutes Apgar score of 7 or above were 166 (70.94%).  Twenty-one (8.97%) babies were admitted to NICU and perinatal mortality was 6 (2.54%).  Conclusion Out of 234 patients who underwent CS due to abnormal CTG, more than 2/3rd of patients had normal babies with an Apgar score of 7 or more, which indicates that abnormal CTG alone should not be used as an indication for CS  Keywords: Fetal Distress, CTG, Caesarean section